Definitive Radiotherapy for Local Recurrence of NSCLC After Surgery

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Abstract

Micro-Abstract

The optimal management and prognosis of locally recurrent non–small-cell lung cancer after surgery is not well described. To our knowledge, this is the largest reported series of such patients treated with definitive radiation. We found generally favorable survival using this approach (median, 23 months), and patients treated with higher radiation doses and intensity-modulated radiation did particularly well.

Introduction:

Locoregional recurrence after resection of non–small-cell lung cancer (NSCLC) is common. We examined outcomes after definitive radiotherapy (RT) to identify prognostic factors for survival and further recurrence.

Patients and Methods:

We reviewed 152 patients who received RT for locoregional recurrent (LR)-NSCLC, and analyzed subsequent overall survival (OS), locoregional failure (LRF), distant metastasis (DM), and any disease progression (LRF and DM).

Results:

Two- and 5-year OS were 49% and 28%, respectively. Two- and 5-year LRF, DM, and any disease progression rates were 40% and 45%, 33% and 37%, and 53% and 57%, respectively. Performance status and intensity-modulated RT (IMRT) were independently associated with OS, as was RT dose ≥ 60 Gy. Stage, chemotherapy at recurrence, and surgery to recurrence interval were not independently associated with outcome. Chemotherapy at initial presentation, adenocarcinoma histology, and male sex were independently associated with higher rates of DM.

Conclusion:

To our knowledge, this is the largest reported series of LR-NSCLC treated with definitive RT. Survival appears comparable to or greater than that of primary NSCLC. Subsequent LRF is more common than distant failure. Established prognostic factors for primary NSCLC, such as chemotherapy and stage, were not clearly prognostic in this analysis. IMRT and higher RT doses were associated with improved survival, though IMRT patients were also treated more recently. These data support definitive-intent RT with optimal dose and technique in such patients.

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